Speaking up or remaining silent about patient safety concerns in rehabilitation: A cross-sectional survey to assess staff experiences and perceptions.

Background and Aims Patient safety incidents may be prevented if healthcare workers speak up to voice their concerns when they observe hazardous clinical situations. This study aims to investigate the frequency of speaking up and healthcare workers' perception of organizational climate in rehabilitation clinics. Methods An online survey was conducted in five rehabilitation clinics. An existing survey instrument (Speaking Up About Patient Safety Questionnaire [SUPS-Q]) was adapted for this purpose. The instrument includes items on self-reported speak-up-related behavior (perceived safety concerns, withholding voice, and speaking up), anticipated speak-up behavior, barriers to speaking up, and speak-up-related climate measures (psychological safety, encouraging environment, and resignation). Data analysis included descriptive statistics, one-way analysis of variance for differences between groups, multiple regression, and measures for validity and reliability of the scales.\ud Results Four hundred seventy-one individuals participated in the survey (response rate of 32%). In the 4 weeks preceding the survey, 81% of respondents had specific concerns about patient safety, 83% performed speak up and 41% remained silent in one or more instances. Expected differences between professional groups were confirmed, but surprisingly, we found no effect of hierarchical level on speaking up behavior and perception of the speak-up climate. Factors that most frequently prevented healthcare workers from speaking up were ineffectiveness (38%), presence of patients (26%), and unpredictability of the actor's reaction (25%). The psychometric evaluation of the adapted SUPS-Q showed acceptable results for validity and reliability. Conclusions Healthcare workers in rehabilitation clinics frequently perceive safety concerns. The study underlines the importance of promoting a culture of safety and speaking up. The short survey instrument SUPS-Q can be used by rehabilitation clinics to initiate discussions related to facilitators and barriers to speaking up and to identify areas for improvement within the organization

Quality standards for safe medication in nursing homes: development through a multistep approach including a Delphi consensus study.

OBJECTIVES The aim of the study was to develop quality standards reflecting minimal requirements for safe medication processes in nursing homes. DESIGN In a first step, relevant key topics for safe medication processes were deducted from a systematic search for similar guidelines, prior work and discussions with experts. In a second step, the essential requirements for each key topic were specified and substantiated with a literature-based rationale. Subsequently, the requirements were evaluated with a piloted, two-round Delphi study. SETTING Nursing homes in Switzerland. PARTICIPANTS Interprofessional panel of 25 experts from science and practice. PRIMARY AND SECONDARY OUTCOME MEASURES Each requirement was rated for its relevance for a safer and resident-oriented medication on a 9-point Likert-Scale based on the RAND/UCLA method. The requirements were considered relevant if, in the second round, the median relevance rating was ≥7 and the proportion of ratings ≥7 was ≥80%. RESULTS Five key topics with a total of 87 requirements were elaborated and rated in the Delphi study. After the second round (response rate in both rounds 100%), 85 requirements fulfilled the predefined criteria and were therefore included in the final set of quality standards. The five key topics are: (I) 'The medication is reviewed regularly and in defined situations', (II) 'The medication is reviewed in a structured manner', (III) 'The medication is monitored in a structured manner', (IV) 'All healthcare professionals are committed to an optimal interprofessional collaboration' and (V) 'Residents are actively involved in medication process'. CONCLUSIONS We developed normative quality standards for a safer and resident-oriented medication in Swiss nursing homes. Altogether, 85 requirements define the medication processes and the behaviour of healthcare professionals. A rigorous implementation may support nursing homes in taking a step towards safer and resident-oriented medication

Speaking up about patient safety in psychiatric hospitals - a cross-sectional survey study among healthcare staff.

Speaking up is an important communication strategy to prevent patient harm. The aim of this study was to examine speak up-related behaviour and climate for the first time in psychiatric hospitals. A cross-sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland. Measures assessed speak up-related behaviour with 11 items organized in three scales (the frequency of perceived safety concerns, the frequency of withholding voice, and the frequency of speaking up). Speak up-related climate was assessed by 11 items organized in 3 subscales (psychological safety for speaking up, encouraging environment for speaking up, and resignation). Statistical analyses included descriptive statistics, reliability, correlations and multiple regression analysis, confirmatory factor analysis, and analysis of variance for comparing mean scores between professional groups. A total of 817 questionnaires were completed (response rate: 23%). In different items, 45%-65% of HCWs reported perceived safety concerns at least once during the past four weeks. Withholding voice was reported by 13-25% of HCWs, and speaking up was reported by 53%-72% of HCWs. Systematic differences in scores were found between professional groups (nurses, doctors, psychologists) and hierarchical groups (lower vs higher status). The vignette showed that hierarchical level and perceived risk of harm for the patient were significant predictors for the self-reported likelihood to speak up. Situations triggering safety concerns occur frequently in psychiatric hospitals. Speaking up and voicing concerns should be further promoted as an important safety measure

Do quantitative levels of antispike-IgG antibodies aid in predicting protection from SARS-CoV-2 infection? Results from a longitudinal study in a police cohort.

In a COVID-19 sero-surveillance cohort study with predominantly healthy and vaccinated individuals, the objectives were (i) to investigate longitudinally the factors associated with the quantitative dynamics of antispike (anti-S1) IgG antibody levels, (ii) to evaluate whether the levels were associated with protection from SARS-CoV-2 infection, and (iii) to assess whether the association was different in the pre-Omicron compared with the Omicron period. The QuantiVac Euroimmun ELISA test was used to quantify anti-S1 IgG levels. The entire study period (16 months), the 11-month pre-Omicron period and the cross-sectional analysis before the Omicron surge included 3219, 2310, and 895 reactive serum samples from 949, 919, and 895 individuals, respectively. Mixed-effect linear, mixed-effect time-to-event, and logistic regression models were used to achieve the objectives. Age and time since infection or vaccination were the only factors associated with a decline of anti-S1 IgG levels. Higher antibody levels were significantly associated with protection from SARS-CoV-2 infection (0.89, 95% confidence interval [CI] 0.82-0.97), and the association was higher during the time period when Omicron was predominantly circulating compared with the ones when Alpha and Delta variants were predominant (adjusted hazard ratio for interaction 0.66, 95% CI 0.53-0.84). In a prediction model, it was estimated that >8000 BAU/mL anti-S1 IgG was required to reduce the risk of infection with Omicron variants by approximately 20%-30% for 90 days. Though, such high levels were only found in 1.9% of the samples before the Omicron surge, and they were not durable for 3 months. Anti-S1 IgG antibody levels are statistically associated with protection from SARS-CoV-2 infection. However, the prediction impact of the antibody level findings on infection protection is limited

Serosurveillance after a COVID-19 Vaccine Campaign in a Swiss Police Cohort

Introduction: To assess the risk for COVID-19 of police officers, we are studying the seroprevalence in a cohort. The baseline cross-sectional investigation was performed prior to a vaccination campaign in January/February 2021, and demonstrated a seroprevalence of 12.9%. Here, we demonstrate serosurveillance results after a vaccination campaign. Methods: The cohort consists of 1022 study participants. The 3-month and 6-month follow-up visits were performed in April/May and September 2021. Data on infection and vaccination rates were obtained via measuring antibodies to the nucleocapsid protein and spike protein and online questionnaires. Results: The mean age of the population was 41 (SD 8.8) years, 72% were male and 76% had no comorbidity. Seroconversion was identified in 1.05% of the study population at the 3-month visit and in 0.73% at the 6-month visit, resulting in an infection rate of 1.8% over a time period of 6 months. In comparison, the infection rate in the general population over the same time period was higher (3.18%, P=0.018). At the 6-month visit, 77.8% of participants reported being vaccinated once and 70.5% twice; 81% had an anti-S antibody titer of >250 U/mL and 87.1% of ≥2 U/mL. No significant association between infection and job role within the department, working region, or years of experience in the job was found. Anti-spike antibody titers of vaccinated study participants showed a calculated decreasing trend 150 to 200 days after the second vaccine dose. Conclusion: These data confirm the value of the vaccination campaign in an exposed group other than healthcare professionals

MetNH3: Metrology for Ammonia in Ambient Air

Measuring ammonia in ambient air is a sensitive and priority issue due to its harmful effects on human health and ecosystems. Ammonia is increasingly being globally acknowledged as a key precursor to atmospheric particulate matter. The European Directive 2001/81/EC on “National Emission Ceilings for Certain Atmospheric Pollutants (NEC)” regulates ammonia emissions in the member states. However, due to the chemical characteristics of ambient ammonia traceable on-line measurements still have significant challenges in analytical technology, uncertainty, quality assurance and quality control (QC/QA). Currently the UK National Ammonia Monitoring Network uses an accredited off-line low temporal resolution and on-line denuder–IC methods at the UK Supersites. There is a need for traceable ammonia measurements which will be vitally important for identifying changes in environment policies, climate and agricultural practice. This in turn should lead to improvements emission inventory uncertainties and for providing independent verification of atmospheric model predictions. MetNH3 (EMRP Joint Research Project) has worked with SMEs in testing improved reference gas mixtures by static and dynamic gravimetric generation methods, develop and refine existing laser based optical spectrometric standards and establishing the transfer from high-accuracy standards to field applicable methods. The first results from the metrological characterisation of a commercially available cavity ring-down spectrometer (CRDS) are presented and the results from a new design “Controlled Atmosphere Test Facility (CATFAC)”, which is currently characterising the performance of diffusive samplers. The range and characteristics of instruments are discussed. The plans for a major ammonia field intercomparison in 2016 will be outlined

Metrology for Ammonia in Ambient Air. Final publishable JRP report

This project developed reference standards and measurement techniques for traceable measurements of NH3 in air. These will enable validated high quality ammonia measurement data which will help monitor and compare NH3 levels and ensure compliance with environmental protection policies and legislation

Implications of involving pharmacy technicians in obtaining a best possible medication history from the perspectives of pharmaceutical, medical and nursing staff: a qualitative study.

OBJECTIVES In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technicians. DESIGN Qualitative study with semistructured interviews. Data were analysed using a qualitative content analysis approach. SETTING Internal medicine units in two mid-sized Swiss hospitals. PARTICIPANTS 21 staff members working at the two sites (6 pharmacy technicians, 2 pharmacists, 6 nurses, 5 physician residents and 2 senior physicians). RESULTS Pharmacy technicians generally appreciated their new tasks in obtaining a BPMH. However, they also experienced challenges associated with their new role. Interviewees reported unease with direct patient interaction and challenges with integrating the new BPMH tasks into their regular daily duties. We found that pharmacists played a key role in the BPMH process, since they act as coaches for pharmacy technicians, transmit information to the physicians and reconcile preadmission medication lists with admission orders. Physicians stated that they benefitted from the delegation of administrative tasks to pharmacy technicians. Regarding the interprofessional collaboration, we found that pharmacy technicians in the study acted on a preliminary administrative level and did not become part of the larger treatment team. There was no direct interaction between pharmacy technicians and physicians, but rather, the supervising pharmacists acted as intermediaries. CONCLUSION The tasks assumed by pharmacy technicians need to be clearly defined and fully integrated into existing processes. Engaging pharmacy technicians may generate new patient safety risks and inefficiencies due to process fragmentation. Communication and information flow at the interfaces between professional groups therefore need to be well organised. More research is needed to understand if and under which circumstances such a model can be efficient and contribute to improving medication safety

Ausgewählte sicherheitsrelevante Medikationsprozesse in Schweizer Alters- und Pflegeheimen: Status quo und Optimierungspotenziale

BACKGROUND Reducing adverse drug events in nursing homes is a central patient safety concern. The aim of this study was to assess how often selected medication processes to increase medication safety are already implemented in Swiss nursing homes and to examine how nursing homes that have not yet implemented these processes can be characterized based on their organizational features. METHODS Cross-sectional survey study among directors of nursing in Swiss nursing homes. RESULTS 420 of 1,525 invited individuals participated in the survey (response rate: 27.5 %). Of these, 65.0 % stated that regular systematic medication reviews have been provided in their institution. 9.5 % of the nursing homes use a list to identify potentially inappropriate medication, and 6.7 % of the nursing homes have a standardized process to monitor side effects of medications. 66.0 % of the participating nursing homes have implemented at least one of these three processes, 34.0 % of the participating nursing homes have not implemented any of the three processes. Statistically significant differences in process implementation were found according to the geographical location of the nursing home, the type of documentation used for medications, the physician model, the number of external general practitioners, as well as the medication supply channel and the legal obligation to cooperate with pharmacists. No differences were found with regard to the nursing home size. CONCLUSION In Swiss nursing homes, central safety-relevant medication processes have not yet been implemented nationwide. In particular, implementation is not widespread in nursing homes where medical care for their residents is provided by many different external general practitioners. The organizational features need to be taken into account to successfully implement quality improvement measures.Hintergrund Die Reduktion von unerwünschten Arzneimittelereignissen bei Bewohnenden von Alters- und Pflegeheimen ist ein zentrales Anliegen der Patientensicherheit. Ziel dieser Studie war es zu ermitteln, wie häufig ausgewählte Medikationsprozesse zur Erhöhung der Medikationssicherheit in Schweizer Pflegeheimen bereits umgesetzt werden und wie sich Heime, die diese Prozesse noch nicht umsetzen, durch organisationale Merkmale charakterisieren lassen. Methode Querschnittstudie mittels Online-Befragung von Pflegedienstleitungen in Schweizer Alters- und Pflegeheimen. Ergebnisse Es nahmen 420 von 1525 eingeladenen Personen an der Befragung teil (Rücklaufquote: 27.5%). Davon gaben 65.0% an, dass in ihrer Einrichtung eine regelmäßige systematische Überprüfung der Medikation vorgesehen ist. In 9.5% der Pflegeheime wird eine Liste zur Identifikation von potenziell inadäquater Medikation eingesetzt und 6.7% der Heime haben einen standardisierten Prozess, um Nebenwirkungen von Medikamenten zu überwachen. 66.0% der teilnehmenden Heime setzen mindestens einen dieser Prozesse um, 34.0% setzen keinen der drei Prozesse um. Statistisch signifikante Unterschiede in der Umsetzung der Prozesse zeigten sich nach Standort des Pflegeheims, der Art des Dokumentationssystems für die Medikation, dem Arztmodell, der Anzahl externer Ärzte/Ärztinnen sowie dem Bezugskanal der Medikamente und der gesetzlichen Verpflichtung zur Zusammenarbeit mit Apothekern/Apothekerinnen. Keine Unterschiede zeigten sich nach Heimgröße. Schlussfolgerung In Schweizer Alters- und Pflegeheimen sind zentrale sicherheitsrelevante Medikationsprozesse noch nicht flächendeckend umgesetzt. Besonders in Einrichtungen, in denen viele externe Belegärzte Bewohnende betreuen, ist die Umsetzung noch wenig fortgeschritten. Die organisationalen Merkmale müssen für eine erfolgreiche Implementierung von Verbesserungsmassnahmen berücksichtigt werden